L14: Patients Experiencing Surgery Flashcards
what is a major surgery?
surgery that involves extensive reconstruction or alteration in the body
e.g. CABG surgery
what is a minor surgery?
surgery that involves minimal alteration in body parts
e.g. cataract surgery
what is an elective surgery?
non-life-saving surgery done because of patient choice
e.g. bunionectomy
what is an urgent surgery?
surgery that is necessary for patient health but not an emergency
e.g. gall bladder removal
what is an emergency surgery?
a surgery that must be done immediately
e.g. repair of a burst appendix
what is a diagnostic surgery?
surgical exploration to diagnose problem
e.g. laparotomy
what is an ablative surgery?
excision or removal of a diseased body part
e.g. amputation or removal of appendix
what is a palliative surgery?
surgery that relieves or reduces intensity of disease symptoms but does not cure
e.g. colostomy or debridement of necrotic tissue
what is reconstructive/restorative surgery?
surgery that restores function or appearance to traumatized or malfunctioning tissues
e.g. internal fixation of a fracture or scar revision
what is procurement for transplant surgery?
removal of tissue or organs from a deceased person for use in another person
e.g. kidney, heart
what is constructive surgery?
surgery that restores function lost or reduced due to congenital anomalies
e.g. cleft palate repair
what is cosmetic surgery?
surgery meant to improve personal appearance
e.g. rhinoplasty
how are surgeries classified(3)?
1) seriousness
2) urgency
3) purpose
what are the subclassifications of surgical seriousness(2)?
1) major
2) minor
what are the subclassifications of surgical urgency(3)?
1) elective
2) urgent
3) emergency
what are the subclassifications of surgical purpose(7)?
1) diagnostic
2) ablative
3) palliative
4) reconstructive/restorative
5) procurement for transplant
6) constructive
7) cosmetic
what are surgical risk factors(9)?
1) smoking
2) age
3) nutrition
4) obesity
5) obstructive sleep apnea (OSA)
6) immunosuppression
7) fluid and electrolyte imbalance
8) post operative nausea and vomiting (PONV)
9) venous thromboembolism (VTE)
cigarette smoking by surgical patients is associated with which perioperative complications(2)?
1) respiratory problems
2) poor wound healing
very young and older patients are at greater surgical risk. why?
immature or declining physiological status
risk of surgical mortality increases as the patient’s weight increases, why?
primarily due to ventilatory and cardiac function
why are surgical patients with obstructive sleep apnea (OSA) at increased risk
back-lying, sedatives, analgesics, and general anesthesia causes relaxation of upper airway and can lead to severe apnea and hypoxia
immunosuppressed patients undergoing surgery are at increased risk of…
developing an infection after the surgery
A patient who is hypovolemic preoperatively or who has serious electrolyte alterations is at significant risk when?
both during and after surgery
post operative nausea and vomiting (PONV) can lead to what(3)?
1) pulmonary aspiration
2) dehydration
3) arrhythmias
these result from fluid and electrolyte imbalances
which patients are most at risk for developing venous thromboembolism(3)?
1) those who undergo surgeries under total anesthetic and surgical time >90 minutes; 60 minutes for pelvis or lower limb surgeries
2) acute surgical admissions with inflammatory or intraabdominal conditions
3) those with significant mobility reduction post op
in the preoperative surgical phase, what is involved with assessment(15)?
1) determine pt’s expectations of surgery and recovery
2) include info about advanced directives
3) screen for conditions that increase surgical risks
4) check for complications in prior surgeries
5) risk factors
6) medications
7) allergies
8) smoking, alcohol, and substance use
9) pregnancy
10) perceptions and knowledge regarding surgery
11) sources of support
12) occupation
13) preop pain assessment
14) review of emotional health
15) cultural and spiritual factors
what is malignant hyperthermia?
an inherited life-threatening condition that can occur during surgery
what food allergies have shown a cross sensitivity to latex?
1) bananas
2) chestnuts
3) kiwi
4) avocadoes
5) potatoes
6) strawberries
7) nectarines
8) tomatoes
9) wheat
plan aggressive pulmonary hygiene for surgical patients who smoke, including(3):
1) more frequent turning
2) breathing and coughing exercises
3) incentive spirometry
patients with a history of excessive alcohol use are often…
malnourished
what does providing education about pain do to preoperative anxiety?
it reduces preoperative anxiety which is frequently associated with postoperative pain.
what is involved with a review of a preop patient’s emotional health(3)?
1) self-concepts
2) body image
3) coping resources
what are some physiological effects of stress?
activation of endocrine system results in release of hormones and catecholamines which increases:
1) BP
2) HR
3) RR
- platelet aggregation also occurs
Common nursing diagnoses relevant to the patient having surgery include:
Ineffective airway clearance
Anxiety
Ineffective Coping
Impaired skin integrity
Risk for aspiration
Risk for perioperative positioning injury
Risk for infection
Deficient knowledge (specify)
Impaired physical mobility
Ineffective thermoregulation
Nausea
Acute pain
Delayed surgical recovery
a pregnant patient only has surgery on what basis?
only on an emergent or urgent basis due to the increased risk of complications
a partial or complete physical assessment is performed on a patient going in to surgery. what does the type of physical exam depend on?
it depends on the amount of time available and the patients preop condition
what does preoperative vitals provide?
baseline data
who should you notify if the patient has an elevated temperature?
the surgeon
what does assessment of the mucous membranes provide?
reveals the level of a patient’s hydration; dehydration increases risk of surgical complications
what are the three primary causative factors of DVT?
Virchow’s Triad:
1) venous stasis
2) vessel wall injury
3) hypercoagulability
why is assessing a baseline neurological status important?
assists with assessment of ascent (awakening) from anesthesia
what is involved with a preoperative assessment of the abdomen?
1) size
2) shape
3) symmetry
4) presence of distention
when will a patients blood type be assessed?
elective surgery - 1 to 7 days before surgery
what is autotransfusion?
reinfusion of a patient’s own blood (more common than transfusions today)
patients requiring emergent surgery often…
experience changes in their physiology status that require urgent reprioritizations
when should nurses review and modify their plans when dealing with surgical patients?
during the intraoperative and postoperative periods
what needs to happen before a surgery can legally and ethically take place?
what is the exception?
a patient needs to fully understand the surgical procedure and all of its implications
the exception is emergency situations
before a surgery is performed, where must a copy of consent be documented?
in the patient’s medical record
what must the surgeon explain before informed consent is given(6)?
1) the procedure
2) associated risks
3) benefits
4) alternatives
5) possible complications
6) who will perform the procedure
what are health promotion activities in the preoperative phase(5)?
1) preoperative teaching
2) postoperative activity resumption
3) pain-relief measures
4) rest
5) feelings regarding surgery
what is involved with preoperative teaching(7)?
1) reasons for preoperative instructions and exercises
2) preoperative routines
3) surgical procedure
4) time of surgery
5) post op unit and location of family during surgery and recovery
6) post op monitoring and therapies
7) sensory preparation
who gives periodic reports to family of a patient undergoing surgery?
the circulating nurse
pain relief is more effective when given…
around the clock (ATC) rather than as needed (prn)
what are acute care activities in the preoperative phase(4)?
1) minimizing the risk of surgical site infection
2) maintaining normal fluid and electrolyte balance
3) preventing bowel incontinence and contamination
4) preparation on the day of surgery
what are some ways to minimize the risk of surgical site infection in the preoperative phase(3)?
1) antibiotics
2) skin antisepsis
3) clipping instead of shaving hair
what are some ways to maintain fluid and electrolyte balance in the preoperative phase(3)?
1) fasting before surgery
2) IV fluid replacement
3) parenteral nutrition (PN)
when are antibiotics started and stopped to prevent surgical site infection?
start: 60 minutes prior to incision
stop: within 24 hours after surgery
describe fasting recommendations for
* clear liquids
* breast milk
* formula or non-human milk
* light meal of toast and clear liquids
* meat or fried foods
- clear liquids - 2 hours or more
- breast milk - 4 hours
- formula or non-human milk - 6 hours
- light meal of toast and clear liquids - 6 hours
- meat or fried foods - 8 hours
some surgeons still require pt not eat anything after midnight prior to surgery
if the surgery involves the lower GI system, what kind of bowel preparations are often made?
cathartic or enema
what is the limit to consecutive enemas? why?
three, too many can cause fluid and electrolyte imbalance
what is involved with preparation on the day of surgery(10)?
1) hygiene
2) hair prep and cosmetic removal
3) removal of prosthetics
4) safeguarding valuables
5) preping bowel and bladder
6) vitals
7) DVT prevention
8) preop med administration
9) documentation and hand-off
10) eliminating wrong site wrong procedure surgery
why may a surgeon or anesthetist order preanesthetic drugs before surgery?
to reduce patient anxiety
when may a surgeon order insertion of an indwelling catheter?
if the surgery is going to be long or the lower abdomen is involved
what are the three principles of universal protocol used whenever an invasive procedure is to be performed?
(1) a preoperative verification that ensures that all relevant documents and results of laboratory tests and diagnostic studies are available before the start of the procedure and that the type of surgery scheduled is consistent with the patient’s expectations
(2) marking the operative site with indelible ink to mark left and right distinction, multiple structures, and levels of the spine
(3) a “time out” just before starting the procedure for final verification of the correct patient, procedure, site, and any implants.
what is involved with transport to the operating room(5)?
1) notification
2) transportation
3) verify patients identity - two identifiers
4) family - is allowed to visit before pt is transported to OR then directed to waiting area
5) prep patients room for their return
why must patients be helped by nurses and transporter from the bed to the stretcher?
they are often on preop sedatives; prevents falls
what is the PCU/PSCU?
preanesthesia care unit/presurgical care unit
what are the responsibilities of the PCU nurse(3)?
1) inserts IV catheter
2) administers preop meds
3) monitors vitals
who performs the patient assessment in the PCU or PSCU?
the anesthesia provider
what are the three nursing roles in the intraoperative phase?
1) circulating nurse
2) scrub nurse
3) registered nurse first assistant
what does the circulating nurse manage(9)?
DEFINITELY KNOW THIS
1) patient care activities in the OR suite
2) patient positioning
3) antimicrobial skin prep
4) meds
5) implants
6) placement and function of intermittent pneumatic compression (IPC) devices
7) specimens
8) warming devices
9) surgical counts of instruments and dressings
a scrub nurse is…
either an RN or surgical technologist who is often certified (CST)
what must a scrub nurse have?
a thorough knowledge of each step of the surgical procedure and the ability to anticipate each and every instrument and supply needed by surgeons
what are the responsibilities of scrub nurses?
definitely know this
supply surgeons with instruments and supplies during surgery
a registered nurse first assistant (RNFA) collaborates with the surgeon by(4):
1) handling and cutting tissue
2) using instruments and medical devices
3) providing exposure of the surgical area and hemostasis
4) suturing
when circulating nurses and scrub nurses partner up, what are their responsibilities as a team(2)?
1) ensure patient safety by minimizing the risk of error
2) ensure cost-effective use of supplies
when patients enter the OR, the circulating nurse performs an assessment of the patient that typically includes(3):
1) immediate clinical status
2) skin integrity (surgical site and areas they will lie during surgery)
3) joint function ( when unusual positions are required for the surgery)
what is the primary focus of intraoperative care(4)?
prevent injury and complications related to:
1) anesthesia
2) surgery
3) positioning
4) equipment use
capnography is typically used during surgery to measure what?
ongoing end tital CO2 levels
where should an electrical cautery ground pad be placed?
apply to patient’s skin
what does active intraoperative warming devices prevent?
perioperative hypothermia
what complications of surgery does prevention of hypothermia further prevent(6)?
1) shivering
2) cardiac arrest
3) blood loss
4) SSI
5) pressure ulcers
6) mortality
how long before surgery should warming devices be used on the patient?
30 minutes before surgery
what are the devices used to warm patients during surgery and which is most effective(3)?
1) warm cotton blankets
2) forced air warmers
3) circulating water mattresses
how long after exposure to latex do many patients show signs of anaphylaxis?
30-60 minutes
under general anesthesia patients lose all(3)…
1) sensation
2) consciousness
3) reflexes (including gag and blink)
amnesia related to anesthesia acts as a…
protective measure from the unpleasant events of the procedure
what routes are general anesthetics administered?
IV infusion or inhalation
what are the three phases of general anesthesia?
1) induction
2) maintenance
3) emergence
what occurs during the emergence phase of general anesthesia?
anesthetics are decreased and the patient begins to awaken
describe *regional anesthesia
- what does it do?
- how is it administered?
1) results in loss of sensation in an area of the body by anesthetizing sensory pathways
2) administered via injection along the pathway of a nerve from the spinal cord
what are some complications that can arise from regional anesthesia?
if the anesthesia moves toward the spinal cord it can lead to serious complications like respiratory paralysis
describe local anesthesia
* what does it do?
* when it is commonly used?
* how is it administered?
1) results in loss of sensation at the desired site by inhibiting peripheral nerve conduction
2) commonly used in ambulatory surgeries
3) injected locally or topically
who continuously monitors vitals during surgery?
the anesthesia provider
When conducting preoperative patient and family teaching, you demonstrate proper use of the incentive spirometer. You know that the patient understands the need for this intervention when the patient states, “I use this device to:
A. help my cough reflex.”
B. expand my lungs after surgery.”
C. increase my lung capacity.”
D. drain excess fluid from my lungs.”
B
what determines the phases of recovery and the patient’s length of time spent in convalescence on an acute care nursing unit(3)?
1) type of anesthesia
2) nature of the surgery
3) patient’s previous condition
what are the postop phases involved with *ambulatory surgery**?
phase 2 - 1-2 hours in recovery
convalescence - occurs at home
what are the postop phases involved with surgery involving a hospitalized patient?
phase 1 - occurs in PACU (often lasts a few hours)
phase 2 - recovery occurs on a surgical unit
convalescence - occurs on surgical unit (last 1 or more days)
after receiving hand-off communication from the OR, the PACU nurse conducts a complete systems assessment when?
initial - within the first few minutes
reassessment - every 15 minutes (more if needed)
what is involved with a PACU nurses assessment(8)?
1) vitals
2) LOC
3) airway status
4) condition of dressings and drains
5) pulses distal to site of surgery
6) comfort level
7) IV fluid status
8) urinary output measurements
readiness for discharge from the PACU is dependent on what?
vital sign stability when compared with the baseline preop vitals
what are some standard tools that PACUs use to determine whether patients are ready for discharge(3)?
1) Modified Aldrete score
2) Modified Postanesthesia Recovery Score (PARS)
3) DASAIM Discharge Assessment Tool
what does the PACU staff do during discharge of a patient to another unit(4)?
1) PACU staff transports patient on stretcher to new unit
2) PACU nurse shows receiving nurse the recovery room record and reviews patient condition and course of care
3) PACU nurse also reviews surgeon orders that require attention
4) a complete set of vitals are taken before PACU staff leaves
what score on an Aldrete score sheet does the patient need to be discharged from a PACU?
9 or higher
what areas are involved with an aldrete score sheet(5)?
1) movement of extremities
2) respiration
3) consciousness
4) circulation
5) color
what is the first priority in caring for a postanesthesia patient?
establish a patent airway
what are signs of hemorrhage (internal or external)(5)?
1) BP falling
2) elevated HR and RR
3) thready pulse
4) cool, clammy, pale skin
5) restlessness
who is at highest risk for developing postop hypothermia?
older adults and pediatric patients
what are S/Sx of malignant hypothermia(8)?
1) hypercarbia
2) tachypnea
3) tachycardia
4) premature ventricular contractions (PVCs)
5) unstable blood pressure
6) cyanosis
7) skin mottling
8) muscular rigidity
what are areas of assessment in the postoperative patient(10)?
1) airway and respiration
2) circulation
3) temp control
4) fluid and electrolyte balance
5) neurological function
6) skin integrity and condition of wound
7) metabolism
8) GU function
9) GI function
10) comfort
what effect can anesthesia have on the GU system?
some patients dont regain voluntary control over their GU function for 6-8 hours after anesthesia
what effect can anesthesia have on the GI system?
patients who have abdominal or pelvic surgery often have decreased peristalsis for at least 24 hours after surgery (paralytic ileus); can also cause abdominal distension
note faint or absent bowel sounds discovered during your assessment
“postoperatively, the nurse instructs the patient to perform leg exercises every hour to:
A. maintain muscle tone
B. assess range of motion
C. exercise fatigued muscles
D. increase venous return
D. post op exercises help to prevent pulmonary and vascular complications
what do patients often need to do after discharge from the hospital following surgery?
1) wound care
2) follow activity or diet restrictions
3) continue medication therapy
4) watch for signs and symptoms of complications
what happens with the surgical recovery process if patients are deconditioned and fail to exercise regularly following discharge?
surgical recovery is slowed
a person is considered frail if they have three of the following(5):
1) unintentional weight loss
2) low physical activity
3) slowed motor performance
4) weakness
5) fatigue or exercise intolerance
how do you evaluate perioperative patient’s pain?
using a pain scale
coughing and deep breathing may be contraindicated after which types of surgeries(5)?
1) brain
2) spinal
3) head
4) neck
5) eye
bariatric patients may have improved lung function and vital capacity in which positions?
reverse Trendelenburg or side lying position
what S/Sx in the upper or lower extremities can indicate a thromboembolism(5)?
1) pain
2) tenderness
3) redness
4) warmth
5) swelling
what is mechanical alignment of knee replacement?
considers only the 2D alignment of the limb and knee in the coronal or frontal plane
what is kinematic alignment of knee replacement?
- considers the 3D alignment of components with respect to the center of the femoral head and ankle
- intent is to restore the normal 3D orientation of the three axes that describe normal knee kinematics
what is a continuous femoral nerve block (CFNB)?
continuous femoral nerve block - method of local anesthesia used for knee surgery
- catheter inserted @ thigh
- anesthetic infused via disposable pump
- pt can bring pump home
how do you know if an AUTOFUSER disposable pain control pump is working?
balloon reservoir in the pump will gradually become smaller
